FAQs (Frequently Asked Questions) below are answered by Paul Stabile, PA-C, M.S., who, at the time of the interview, is a physician assistant working at One Medical Group, with extensive experience in primary care and HIV/Hepatitis treatment. He is the former Director of Clinical Care at the W. F. Ryan Community Health Center Network.
Can someone have a “false positive” or “false negative” screening for the Hepatitis C virus? (Are the blood tests accurate?)
The recommended screening test for Hepatitis C (HCV) is a blood test called an enzyme immunoassay (EIA). This test has a greater than 99% sensitivity and specificity — i.e., there’s less than 1% chance that the test result is wrong in diagnosing HCV infection or in ruling it out. However, the EIA only determines if someone has ever been infected by HCV by detecting antibodies, proteins which the body forms in its reaction to the virus. The EIA does not establish if someone has a chronic infection or a resolved infection. Patients who have a positive EIA should have a HCV RNA viral load test, to determine the actual presence of the virus. If this test is positive, the patient is considered to be infected with HCV.
False-negative tests — i.e., when the test result returns negative, but the person is actually infected — occasionally occur, especially during recent infection, when the immune system has not had time to create the antibodies to HCV that the EIA test would normally detect. If a medical provider is concerned about unexplained elevated liver function tests, or suspects an acute HCV infection, he/she may order a HCV RNA viral load blood test. If the virus is detected, the person is considered infected.
Is a liver transplant a viable “cure” for HCC (liver cancer)?
Liver transplant for HCC is considered curative in the setting of HCV infection for most patients. However, a small number of people may have a recurrence of the cancer after transplantation.
What are the common risks associated with surgery when treating HCC?
Liver transplant surgery is a major medical procedure, and carries a risk of significant complications, including:
- Bile duct complications, including bile duct leaks or shrinking of the bile ducts
- Bleeding
- Blood clots
- Failure of donated liver
- Infection
- Problems with memory and other thinking
- Rejection of the donated liver
- Rare but serious complications of general anesthesia, including pneumonia and death
Also, after a liver transplant the transplant recipient must take life-time medications to prevent rejection of the donated liver. These medications can cause side effects, including:
- Bone thinning/weakening, which can cause fractures
- Diabetes
- Diarrhea
- Headaches
- High blood pressure
- High cholesterol
Can HCC “spread” to other organs or other types of cancer?
When cancer cells from a tumor spread to other parts of the body and start growing there, they are called secondary cancers (metastases). The most common sites for primary HCC to spread to are the other organs in the abdominal cavity. The most common sites for more distant metastases are the lungs and brain.
Aside from chronic HBV and HCV infections, are there other known risk factors for HCC? Does genetics play a role; is there a gene test for susceptibility?
In most cases, the cause of liver cancer is usually chronic, long-term scarring of the liver (cirrhosis). Cirrhosis may be caused by:
- Alcohol abuse (the most common cause in the United States)
- Certain autoimmune diseases of the liver
- Diseases that cause long-term inflammation of the liver
- Hepatitis B or C virus infection
- Too much iron in the body (hemochromatosis)
Patients with Hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis. Genetics may play a role in many types of cancers, but no screening test is currently recommended to determine someone’s increased risk of HCC.
Does a regular checkup or examination and blood work from my general practitioner automatically screen for Hepatitis?
Because there is an effective vaccine to prevent Hepatitis B infection, many medical providers screen for exposure to Hepatitis viruses. However, to be sure, you should ask your medical provider regarding this blood test.
Hepatitis C testing is not considered a routine screening test in most primary care settings. Screening is recommended for people with a history of risk of exposure to viral Hepatitis. Exposure risks include:
- Past use of intravenous drugs, even just once
- Blood transfusion or organ transplant before 1992, when screening transfused blood for HCV began
- Hemophiliacs who received blood products before 1987
- HIV infection
- Hemodialysis
- Children born to HCV-infected mothers
- Current sexual partners of HCV-infected persons
- Health care and public safety workers after a needle-stick injury, or mucosal exposure to HCV-positive blood or other body fluids
- Unexplained elevated liver function tests
If you think you are at risk, you should talk with your medical provider.
How often do I need to be screened for Hepatitis C?
Periodic screening should be based upon the recurrence of risk exposures. For sexual partners of HCV-infected persons, periodic screening may be warranted. For people without recurrent risks, e.g., a one-time remote history of drug use, whose HCV test was negative, additional screening may not be necessary.
Is the Hepatitis B vaccination for a lifetime? What is the procedure of the vaccination?
Most people, once vaccinated, will not need a “booster” dose of Hepatitis B vaccine. A “booster” dose increases or extends the effectiveness of the vaccine. Booster doses are recommended only for hemodialysis patients, and can be considered for other people with a weakened immune system, e.g., HIV infection. As a rule, booster doses are not recommended for persons with normal immune status who have been fully vaccinated.
The vaccination schedule most often used for adults and children has been three intramuscular injections; the second and third administered 1 and 6 months after the first. The vaccine is sometimes combined with Hepatitis A vaccine in the same injection.
You should get the Hepatitis B vaccine if:
- You have sex with or live in the same house with a person with Hepatitis B infection
- You have sex with more than one partner
- You seek care in a clinic for sexually transmitted diseases, HIV testing or treatment, or drug treatment
- You are a man who has sex with other men
- You inject drugs
- You have a job that involves contact with human blood
- You are on the staff of, or a client in, an institution for the developmentally disabled
- You are a hemodialysis patient or have end-stage renal disease
- You have HIV infection
- You have chronic liver disease
- You live or travel more than 6 months/year in countries where Hepatitis B is common
- You are a prisoner in a correctional facility
Are the Hepatitis viruses contracted only through sexual contact?
No, in fact, while some types of sexual contact can spread viral Hepatitis, infections are caused by other routes of transmission as well, as below:
HAV infection usually produces a self-limited liver inflammation that does not result in chronic infection or chronic liver disease. On rare occasions, usually when the patient already has underlying chronic liver disease, HAV can cause severe Hepatitis and even death. HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food, feces, or water. Hepatitis A vaccination is the most effective measure to prevent HAV infection and is recommended for all children at age 1; certain international travelers; people with Hepatitis B or C infection; people with chronic liver disease of any cause; people with decreased immune function; and others at risk for HAV infection.
HBV infection of the liver can cause acute, symptomatic illness and often leads to chronic or lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is transmitted through percutaneous (puncture through the skin), or mucosal contact with infectious blood or other body fluids. In some instances, HBV can be transmitted sexually. Hepatitis B vaccination is the most effective measure to prevent HBV infection and its consequences, and is recommended for all infants and others at risk for HBV infection, as outlined above. See answer to question 8 above for more information.
HCV infection of the liver sometimes results in an acute illness, but most often becomes a silent, chronic infection that can lead to cirrhosis, liver failure, liver cancer, and death. Chronic HCV infection develops in a majority of HCV-infected persons, most of whom do not know they are infected, since they have no symptoms until liver disease becomes very severe. HCV is spread by contact with the blood of an infected person. See answer to question 6 above for more information. There is no vaccine for Hepatitis C.
